The cranial orbital buttress technique for nonsyndromic unicoronal and metopic craniosynostosis

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Current craniosynostosis procedures can result in complications due to absorbable plates and screws or other specialized expensive hardware. The authors propose the cranial orbital buttress (COB) technique of frontoorbital remodeling for metopic and unicoronal synostoses, wherein no plates or screws are used. They hypothesize that, with this technique, aesthetically acceptable outcomes for unicoronal and metopic synostosis can be achieved. In this article, they present this technique and compare the results with current frontoorbital remodeling practices.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors conducted a retrospective chart review of cases in which patients with nonsyndromic unicoronal or metopic synostosis underwent cranio-orbital surgery at their institution from 1985 through 2009. Operative parameters, surgical variations, and complications were analyzed. The COB technique uses a 1-piece switch, hemiforeheads, or multiple pieces for forehead remodeling. The supraorbital bar is reconstructed in patients with metopic synostosis using a double wedge or greenstick fracture technique, and in patients with unicoronal synostosis a hinge procedure based on a 1.5-orbital osteotomy is used. The supraorbital bar is advanced and supported in place by bone graft(s) inserted at the lateral aspect(s) of the orbit(s) to form a buttress, with fixation done using absorbable sutures.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 79 cases met the criteria for inclusion in the study. Twenty-nine patients had metopic synostosis, 3 had combined metopic and sagittal synostoses, and 47 had unicoronal synostosis. The patients’ mean age at surgery was 11.4 ± 10.1 months and the mean operative time was 183.4 ± 41.0 minutes. The mean length of hospital stay was 3.7 ± 1.2 days. The mean blood loss was 150.0 ± 125.6 ml, and 33% of patients required a blood transfusion (mean volume 206.9 ± 102.3 ml). In metopic synostosis, hemiforeheads were used most often (24/29, 83%), and the supraorbital bar was remodeled using a bilateral intracranial orbital osteotomy followed by a double wedge modification (23/29, 79%) or a greenstick fracture (4/29 14%) for milder cases. Forehead remodeling for unicoronal synostosis was by a forehead switch (39/47, 83%) and the supraorbital bar was remodeled using a 1.5-orbital intracranial orbital osteotomy (34/47, 72%) such that the bar was advanced on the abnormal side and hinged at the midline of the normal orbit. Perioperative complications occurred in 19% of cases and included dural tears (16%), inconsequential subdural hematoma (1.3%), and nasal greenstick fracture (1.3%). The total reoperation rate was 7.6% (cranioplasties for irregular contours, 6.3%; scar revision, 1.3%).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The COB remodeling technique is simple and efficient, gives acceptable outcomes, and is less resource intensive than previous techniques reported in the literature.</jats:p></jats:sec>

Fronto-orbital advancement and reconstruction using reverse frontal bone graft without the use of orbital bar: a technical note

“…Absorbable plates offer an alternative to rigid fixation but carry higher complications [7,8]. A recent technique of orbital buttress offers an alternative to screws and plates altogether [9]. None of these techniques however addresses the problem of thinning in the bitemporal regions.…”

An Overcorrective Modification of Cranial Vault Reconstruction for Non-Syndromic Metopic Suture Synostosis: Shiraz Technique

“…Subsequently, the blood loss volume and, as a result, the needed transfusion volume were significantly lower in our method. Besides, the mean operation duration of 175 minutes (range: 60-300) is comparable to other techniques; a mean of 183.4 minutes in the cranial orbital buttress technique by Seal et al (17) and 159 minutes in the hinge technique by Magoon et al (14).…”

Frontoorbital Advancement (FOA) using surgical suture. Our experience : single institution

“…To date, frontoorbital remodeling surgery remains the standard of care for metopic and unicoronal craniosynostosis treatment, with techniques varying between centers. Tessier's tongue-in-groove advancement of the roof of the orbits followed by an attachment of a reconstructed forehead bone still remains one of the most commonly reported techniques [3].…”

“…Despite this advance, there still remain risks of postoperative complications when using absorbable hardware [3]. However, hydrolytic foreign body reaction, loss of tensile strength, less stabilisation and more difficult handling have been reported with the implementation of this method [4].…”